| Competition: | |
| Name: | | |
| | First name* | Last name* |
| Address: | | |
| | Post code* Country* | City* |
| | | |
| | Street* | fax number (for case of change) |
| E-mail address* | |
| Affiliation: | |
| Gun: | |
| | product type serial no. caliber |
| Gun (2nd, if any): | |
| | product type serial no. caliber |
| Place and date of the border cross: | |
| Special class: | Lady Junior Senior | Date of birth: |
| | Year/month/day |
| IPSC division: | Standard Open | Modified |
| IPSC power factor: | Minor Major | |
| |
| |